Influence of the COVID‐19 pandemic on Staphylococcus aureus bloodstream infection in children, Henan, China
Authors: Yuanzhe Li, Yang Cao, Xianfei Ding, Debin Yang, Yongtao Duan
Journal: Journal of Infection (2022)

We read with interest the article by Kouijzer and colleagues,1Kouijzer IJE Fowler Jr, VG Ten Oever J. Redefining Staphylococcus aureus bacteremia: a structured approach guiding diagnostic and therapeutic management.J Infect. 2022; (S0163-4453(22)00641-7)PubMed Google Scholar which proposes a new approach to define the extent of infection in patients with Staphylococcus aureus (S. aureus) bacteremia. Zhou et al.2Zhou J Zhao P Nie M Gao K Yang J Sun J. Changes of Haemophilus influenzae infection in children before and after the COVID-19 pandemic, Henan, China.J Infect. 2022; (S0163-4453(22)00615-6)Abstract Full Text Full Text PDF Google Scholar found a reduction in Haemophilus influenzae infection in children during the COVID-19 pandemic; In addition, Duverger et al.3Duverger C Monteil C Souyri V Fournier S. Decrease of carbapenemase-producing Enterobacteriaceae incidence during the first year of the COVID-19 pandemic.J Infect. 2022; 85: 90-122Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar reported a reduction in the incidence of carbapenem-producing Enterobacteriaceae after the COVID-19 pandemic. However, few studies have examined the impact of the COVID-19 pandemic on S. aureus bloodstream infection in children. We hope to provide additional information to support these conclusions by sharing the results of one of our studies, which analyzed changes in S. aureus bloodstream infection in children before and after the COVID-19 pandemic in Henan, China. S. aureus is one of the major pathogens responsible for bloodstream infections or bacteremia, and it is the most commonly isolated single pathogen associated with nosocomial infections.4Musicha P Cornick JE Bar-Zeev N French N Masesa C Denis B et al.Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998-2016): a surveillance study.Lancet Infect Dis. 2017; 17: 1042-1052Abstract Full Text Full Text PDF PubMed Scopus (177) Google Scholar,5Battle SE Shuping M Withers S Justo JA Bookstaver PB Al-Hasan MN. Prediction of mortality in Staphylococcus aureus bloodstream infection using quick Pitt bacteremia score.J Infect. 2022; 84: 131-135Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar It has high rates of morbidity and mortality. According to the sensitivity to methicillin, S. aureus can be divided into methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). Compared with MSSA bacteremia patients, the mortality of MRSA bacteremia patients increased by 40%.6Li X Fang F Zhao J Lou N Li C Huang T et al.Molecular characteristics and virulence gene profifiles of Staphylococcus aureus causing bloodstream infection.Braz J Infect Dis. 2018,; 22: 487-494Crossref PubMed Scopus (35) Google Scholar S. aureus bloodstream infections, particularly MRSA bloodstream infections, seriously threaten the health and lives of children.7Turner NA Sharma-Kuinkel BK Maskarinec SA Eichenberger EM Shah PP Carugati M et al.Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research.Nat Rev Microbiol. 2019; 17: 203-218Crossref PubMed Scopus (954) Google Scholar,8Asgeirsson H Thalme A Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review.Infect Dis (Lond). 2018; 50: 175-192Crossref PubMed Scopus (83) Google Scholar During the COVID-19 pandemic, the government has adopted relatively strict control measures and non-pharmaceutical interventions(NPI), which have changed the original epidemic trend of many pathogens.2Zhou J Zhao P Nie M Gao K Yang J Sun J. Changes of Haemophilus influenzae infection in children before and after the COVID-19 pandemic, Henan, China.J Infect. 2022; (S0163-4453(22)00615-6)Abstract Full Text Full Text PDF Google Scholar,3Duverger C Monteil C Souyri V Fournier S. Decrease of carbapenemase-producing Enterobacteriaceae incidence during the first year of the COVID-19 pandemic.J Infect. 2022; 85: 90-122Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar,9Amin-Chowdhury Z Aiano F Mensah A Sheppard CL Litt D Fry NK et al.Impact of the coronavirus disease 2019 (COVID-19) pandemic on invasive pneumococcal disease and risk of pneumococcal coinfection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): prospective national cohort study, England.Clin Infect Dis. 2021; 72: e65-e75Crossref PubMed Scopus (92) Google Scholar Therefore, analysis of the trend of S. aureus bloodstream infection in children before and after the COVID-19 pandemic can provide a reference for the development of relevant prevention and treatment measures for children. This study was a multicenter retrospective study. To evaluate the impact of COVID-19 on the epidemiological characteristics of S. aureus bloodstream infection in children, we compared and analyzed the laboratory data of children with blood culture records from three large hospitals in Henan Province from 2017 to October 2022. They were all younger than 18 years of age and included 306,404 children (n=45,939 in 2017, n=52,917 in 2018, n=57,755 in 2019, n=40,233 in 2020, n=53,652 in 2021, 2022 n=55,908). When we analyzed the total number of positive blood cultures, the number of S. aureus positive blood cultures, and the number of MRSA positive blood cultures (Fig. 1a), as well as the S. aureus positive rate and the MRSA positive rate (Fig. 1b), according to year, we found that the total number of positive blood cultures, the number of S. aureus positive blood cultures, and the number of MRSA positive blood cultures all decreased significantly in 2020 after the outbreak of the COVID-19 pandemic. In addition, the positive rate of MRSA in S. aureus bloodstream infections in children was higher (55.7% in 2017, 72.0% in 2018, 58.3% in 2019, 49.1% in 2020, 53.1% in 2021 and 55.9% in 2022). The prevalence of S. aureus and MRSA decreased after the COVID-19 pandemic, indicating that the epidemiological characteristics of S. aureus bloodstream infection in children were significantly affected by the COVID-19 pandemic. However, the total number of positive blood cultures, the positive number and positive rate of S. aureus and the positive number and positive rate of MRSA have increased in 2021, and the number of positive S. aureus and MRSA in 2022 has approached the level before the COVID-19 pandemic, so we need to be alert to the risk of recurrence. The rise of antibiotic resistance remains a global crisis. With the widespread use of highly effective antimicrobials in clinical practice, MRSA resistance has increased, and the picture for multi-drug resistance is grim. We analyzed the resistance of MRSA strains to common antimicrobial agents before and after the COVID-19 pandemic (Table 1).In addition, our analysis of children with S. aureus bloodstream infection according to different age groups found that the number of S. aureus positive (Fig. 2a) and the positive rate (Fig. 2b), the number of MRSA positive (Fig. 2c) and the positive rate (Fig. 2d) decreased in children under 3 years old after the COVID-19 pandemic, and the downward trend was more significant in infants under 1 years old. Interestingly, before and after the COVID-19 pandemic, S. aureus as well as the number of MRSA infections accounted for the highest proportion of infants younger than 1 year, indicating that S. aureus and MRSA infections were predominantly in infants younger than 1 year, a feature that does not seem to be related to the COVID-19 pandemic.Table 1Analysis of drug resistance of MRSA strains to common drugs from 2017 to 2022.Drugs2017(n=64)2018(n=67)2019(n=88)2020(n=27)2021(n=34)2022(n=52)Penicillin64(100)67(100)88(100)27(100)34(100)52(100)Ampicillin64(100)67(100)88(100)27(100)34(100)52(100)Erythromycin60(93.7)59(88.1)80(90.1)23(85.2)29(85.3)46(88.5)Clindamycin58(90.6)58(86.6)78(88.6)22(81.5)28(82.4)45(86.5)Tetracycline17(26.6)13(19.4)16(18.2)6(22.2)6(17.7)11(21.2)Cotrimoxazole6(9.4)5(7.5)7(7.9)2(7.4)2(5.9)4(7.7)Gentamicin4(6.3)3(4.5)4(4.5)1(3.7)2(5.9)3(5.8)Rifampicin3(4.7)4(5.9)3(3.4)2(7.4)2(5.9)4(7.7)Ciprofloxacin3(4.7)2(2.9)2(2.3)1(3.7)1(2.9)3(5.8)Teicoplanin0(0)0(0)0(0)0(0)0(0)0(0)Vancomycin0(0)0(0)0(0)0(0)0(0)0(0)Linezolid0(0)0(0)0(0)0(0)0(0)0(0) Open table in a new tab In summary, the ongoing COVID-19 pandemic and associated public health measures have altered the epidemic trend of S. aureus bloodstream infection in children in Henan, China. During the COVID-19 pandemic, the number of positive cases and positive rates of S. aureus and MRSA showed a downward trend. However, with the easing of the COVID-19 pandemic and the relaxation of relevant policies, the number of S. aureus bloodstream infections in children has shown signs of recovery, which should cause us to remain vigilant and closely monitor their trends.